The relevance of complying with OSHA's guideline safety controls for home healthcare workers has recently taken on greater significance due to proposals filed in Congress which call on the Secretary of Labor to issue an enforceable safety and health standard similar to OSHA's guidance.

At the end of last year, Connecticut Rep. Joe Courtney introduced a Congressional bill entitled the “Workplace Violence Prevention for Health Care and Social Workers Act” (PDF). The bill, if passed, will direct the Secretary of Labor to issue an enforceable safety and health standard similar to OSHA's “Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers” (PDF).

Although a number of states have implemented workplace violence prevention programs for healthcare facilities, many of the programs are location-specific inasmuch as they only address threats in certain areas such as Emergency Rooms or Psychiatric Units. What is significant about OSHA's Guidelines is that they take into account the risks faced on a daily basis by home healthcare workers.

The Risks Faced by Home Healthcare Workers

The risks faced by home healthcare workers are exactly the same as those faced by on-premises healthcare workers - typically violence, verbal aggression, and sexual assault. The difference between the venues is that when a home healthcare worker is attacked, the event occurs when they are working alone and isolated from the safety controls one would find in a healthcare facility.

Unfortunately, it is impossible to quantify how many home healthcare workers are the victims of violence, verbal aggression, and sexual assault due to significant underreporting. However, one survey reported healthcare workers working in the community were twice as likely to experience violence or aggression at work as on-premises healthcare workers.

Administrative Safety Controls for Home Healthcare Workers

OSHA's administrative safety controls for home healthcare workers appears under the “Administrative and Work Practice Controls” of the guidance. The safety controls divide responsibility for safety between nursing managers and home healthcare workers inasmuch as nursing managers are responsible for providing relevant training and developing safety procedures, while workers have a duty to report all assaults, attempted assaults, or threats of assaults, and maintain logbooks of such incidents.

In addition, home healthcare workers should have specific log-in and log-out procedures that require them to contact their nursing manager's office before and after each patient visit. The log-in/log-out procedures should include:

• The name and address of the patient being visited.
• The expected duration of the visit.
• A code word to use in the event of an incident.
• Details of any travel plans with the patient.

The home healthcare worker must contact the office if the plans change or the visit overruns, while office personnel must have procedures to follow if a worker fails to log in as expected.

Physical Safety Controls for Home Healthcare Workers

When working in an environment where there is a high risk of an assault, OSHA recommends implementing a “buddy system”, or giving workers the discretion to receive back-up assistance from another worker or a law enforcement office. In every event, OSHA's guidelines state workers have an effective means of communication, and suggests a cell phone or panic button.

Although OSHA is technology neutral when it comes to suggesting what type of personal safety or panic button system is implemented, it makes sense to use a smartphone app rather than a wearable device that connects via Bluetooth to a smartphone - the reason being that, with a wearable device that connects to a smartphone, personnel have to keep two devices charged instead of one. There is also more likelihood of a wearable device being forgotten and some Bluetooth-enabled panic buttons have been found to have security flaws which may make them unreliable safety controls in an emergency.

A Smartphone Personal Safety App for Home Healthcare Workers

By comparison, one personal safety mobile app provides location-based alerting to security or 9-1-1 with a tap of a smartphone screen. Nursing managers are simultaneously alerted to an attack to facilitate a coordinated response, and the event is automatically logged on a management console. Employees can be provided with a virtual escort every time they travel.

Community nurses, personal home care aides, and other traveling staff practice in some of the most dangerous situations in the healthcare industry, often without nearby support. Our new report demonstrates how technology can empower traveling healthcare workers' personal safety.

The healthcare industry is one of the most dangerous places to work in the U.S. In addition to a high rate of occupation injuries due to musculoskeletal disorders, exposure to pathogens, and slips, trips, and falls, incidents of serious workplace violence are four times more common in the healthcare industry than in private industry on average according to data from the Bureau of Labor Statistics (PDF).

In reality, the situation is likely to be much worse. A survey conducted in 2013 by the Wayne State University of Medicine in Detroit found a workplace violence underreporting rate of 77% - which increased to 88% due to supervisors failing to document reports. One of the reasons given for the underreporting rate is that the victims of workplace violence did not know how to make a report.

The Level of Threats to Traveling Healthcare Workers' Personal Safety

The results of the Detroit survey invalidate many other statistics relating to workplace violence in healthcare. Therefore, although it was claimed by the New England Journal of Medicine that 61% of community nurses, personal home care aides, and other traveling staff report workplace violence annually, the actual number of victims could be considerably higher with the consequence being that, without full knowledge of the scale of workplace violence, prevention efforts are mostly inadequate.

However, assuming the rate of underreporting is equally dividing between on-premises healthcare employees and off-premises healthcare employees, a survey published in the British Medical Journal found that nurses working remotely were twice as likely to experience violence or aggression at work as those working on-premises. The discrepancy was attributed to patients' homes being uncontrolled work environments in which none of the usual safety features of a healthcare facility were present.

Efforts to Reduce Workplace Violence in the Healthcare Industry

What efforts have been made to reduce workplace violence in the healthcare industry have mostly occurred at state level. Forty-two states have legislation on their statutes that either establish or increase penalties for violence against healthcare professionals, and eight of these states also make it a licensing requirement that healthcare facilities run workplace violence prevention programs.

OSHA has also developed guidance for employers and workers in healthcare and social services (PDF), and this guidance has recently become the backbone of a federal bill introduced into Congress by Connecticut Rep. Joe Courtney - with a significant difference being that the language of HR 7141 (PDF) includes a reference to home health care workers, which is noticeably absent from OSHA guidance.

How Tech Empowers Traveling Healthcare Workers' Personal Safety

Courtney's “Workplace Violence Prevention for Health Care and Social Workers Act” does not go as far as Oregon's state legislation for protecting home health care workers. The state's HB 2022 from 2007 (PDF) stipulates that home health care workers have the right to refuse to treat a patient unless they are provided with a “communication device” with which they can alert law enforcement to an assault.

Since 2007 - the year when the first iPhone was released - the range of communication devices available to empower traveling healthcare workers' personal safety has improved dramatically. It is now possible for traveling healthcare workers to download smartphone apps that can alert law enforcement to an assault with two touches of a screen, or that can be used by employers to alert employees of an emergency situation.

Further Benefits of Smartphone Apps for Traveling Healthcare Workers

Apps with a safety timer can be used as virtual escorts to alert employers quickly to a potential assault situation when a timer is activated, or they can be used as a directory of resources for healthcare personnel who have experienced a non-physical assault (i.e. car theft). Importantly the apps can also be used as a means of reporting and recording workplace violence in the healthcare industry so that the scale of the issue becomes more apparent and more effective prevention methods are implemented.

Healthcare managers with a responsibility for the health and safety of community nurses, personal home care aides, and other traveling staff can find out more about how tech empowers traveling healthcare workers' personal safety by downloading our new free report. 

Although OSHA enforces a duty of care on employers to protect staff from foreseeable hazards and has produced guidelines for preventing workplace violence for healthcare and social service workers, most state laws to prevent workplace violence in the healthcare industry fail to protect traveling nurses.

In 2015, a study published in The BMJ revealed that traveling nurses working in the community are twice as likely to experience workplace violence as nurses working on their employers' premises. Although the study was based on community nurses working in the Australian health service, its results mirror those of studies conducted in the UK and elsewhere in Europe.

In the U.S., it is difficult to find accurate statistics relating to workplace violence in the healthcare industry due to substantial under-reporting. To further complicate the distinction between violence directed at traveling nurses and on-premises nurses, OSHA combines home health aides, nursing aides, and psychiatric aides in its Workplace Violence in Healthcare report (PDF).

State Laws to Prevent Workplace Violence in the Healthcare Industry

Despite the under-reporting of workplace violence in the healthcare industry, it has been calculated that the rate of serious workplace incidents (those resulting in workers taking time off to recover from their injuries) is four times higher in the healthcare industry than an average of all other industries combined. To counter this alarming statistic, OSHA provides a series of workplace violence resources:

• Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers (PDF)
• Preventing Workplace Violence. A Road Map for Healthcare Facilities (PDF)
• Workplace Violence Prevention and Related Goals: The Big Picture (PDF)

Many states have increased the criminal penalties for violent assaults on healthcare personnel. However, a number of these laws are “location-specific” (i.e. only apply in Emergency Departments) and fail to take into account violent assaults on healthcare personnel working outside the healthcare facility. Indeed, of nine states that have passed legislation requiring healthcare facilities to implement workplace violence programs, only Oregon's laws specifically address “Home Health Care Services”.

Hope that Federal Action Improves Safety for Traveling Nurses

The failure of state laws to protect traveling nurses is not necessarily the fault of state legislators. Without accurate statistics to work with, many legislators will be unaware of the scale of violence experienced by traveling nurses, so measures are not introduced to address it. Fortunately, proposed action at the federal level may result in better protection against workplace violence for traveling nurses.

Last November, Connecticut Rep. Joe Courtney introduced his Workplace Violence Prevention for Health Care and Social Workers Act (HR 7141). The bill calls on the Secretary of Labor to issue an enforceable safety and health standard similar to OSHA's Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers, but with home health care workers specifically mentioned.

Although the bill has not yet progressed any further than the House Committee on Education and the Workforce, it has some notable co-sponsors - including Rep. Ro Khanna who contributed to California's Workplace Violence Prevention in Health Care standard (PDF) and who introduced his own federal proposals last March (PDF), which significantly contained a section about security communication devices for traveling nurses.

The standard promulgated under this paragraph shall include procedures for hazard evaluation and control that fit the work settings unique to home health and hospice, which shall include, but not be limited to, each of the following:

(A) Procedures to identify and evaluate environmental and patient-specific risk factors such as the presence of weapons, evidence of substance abuse, or the presence of uncooperative cohabitants. At minimum, such procedures must be utilized during intake procedures, at the time of the initial visit, and during any subsequent visit when there has been a change in conditions.

(B) Procedures to correct workplace violence hazards in a timely manner, which shall include, at minimum, procedures to ensure employees will not work alone in households where there is a high risk for violence, provision of functional and maintained security or communication devices for all employees working in a patient or client’s home or community, and provision of dedicated and available security personnel to respond to reports of violent incidents or threats.

(C) Procedures for responding to actual or potential workplace violence emergencies that shall include, at minimum, obtaining help from security personnel required under subparagraph (B), or law enforcement agencies as appropriate.

Khanna Not the First to Call for Security Communication Devices

Rep. Ro Khanna's bill is not the first set of proposals to call for security communication devices for traveling nurses. Oregon´s laws to address workplace violence on traveling nurses stipulates employers must measure the frequency of assaults in the homes of patients receiving home care health services and - regardless of the outcome - employees may refuse to treat a patient unless “equipped with a communication device” they can use to alert law enforcement to an assault.

Although no other states have introduced similar measures to protect traveling nurses, several hospitals have implemented solutions that give traveling nurses one-click access to law enforcement. This solution also receives geo-targeted alert notifications and can act as a virtual escort so healthcare managers are informed when a nurse has been unexpectedly delayed at a patient's home or failed to arrive for their next appointment.

We are only a few weeks into the new year, and workplace safety has already become a major point of conversation in 2019. At Rave, we have noticed a recent interest increase in our corporate safety related content, and these topics show no signs of slowing down. We predict that emergency preparedness will continue to grow in relevancy for business organizations as 2019 continues. 

Critical communications for businesses have become much more in depth over the past few years. Implementing and maintaining corporate emergency plans involve many moving pieces to consider, including technology and communications trends. Here are five pieces to get up to speed and gain insights into modern workplace safety:

1. Survey Analysis: Workplace Safety & Preparedness

Click here to view now.

Last year, Rave surveyed more than 500 employees from various industries across the US about employee perceptions on workplace safety. We have complied our findings into the Workplace Safety and Preparedness Survey Analysis.

Discover the top highlights including insights into preferred communications methods. The analysis also dives deep into findings like generational differences in knowledge of company emergency preparedness plans and more.

Click here to access the survey results >>

2. Case Study: Hurricane Crisis Communication at Medical University of South Carolina

Click here to view now.

In September 2018, Hurricane Florence barreled towards the Carolinas. The crisis communication team at the Medical University of South Carolina (MUSC) enacted its response plan six days prior to landfall, sending messages out to 23,400 members of its campus community.

Read the case study to learn about MUSC’s approach to crisis communications and best practices to communicate with its community, whether on a daily basis or during a natural disaster such as Hurricane Florence.

Learn more about MUSC's experience >>

3. Trend Report: Emergency Preparedness and Security Trends in Healthcare

Click here to view now.

Our survey results examine the current and most pressing emergency concerns for hospitals and healthcare facilities. Learn what respondents consider their biggest safety concerns, what actual events occurred within the previous two years, and what issues they had encountered when communicating emergency incidents to employees, patients, and visitors. The report also identifies several issues with how emergency incidents are communicated.

View the full Healthcare report here >>

4. Whitepaper: Emergency Notification Systems Evaluation: 6 Overlooked Criteria

Click here to view.

Your Emergency Notification System should be evaluated regularly to ensure you are aware of the system capabilities and limitations as well as how these areas may be impacted by advancements made in today’s modern technology.

We conducted a full Emergency Notification Systems evaluation to ensure your corporate safety plan is stronger than just “good enough” when it comes to such lifesaving technology. This whitepaper outlines six areas outside of strict technical criteria that can make or break your emergency communication efforts.

Click here to view the criteria >>

5. Case Study: Multi-National Consumer Goods Manufacturer Sees Rapid Results

Click here to view now.

A global manufacturer of consumer goods was hurting from the cost of poor communications because of their ineffective home grown notification system. To improve communication speed and corporate resiliency, the corporation implanted a  fast, reliable mass notification system. Discover how the organization is now able to rapidly communicate information and saw a $189k return on investment from a single incident.

Read the full case study now >>

Corporate environments across the country are having conversations about safety and emergency preparedness. Last year, more and more businesses began taking steps to protect against, communicate, and minimize the effects of an emergency situation. The past year has shown that emergencies and disasters can strike anywhere, anytime, including businesses. Now that is it 2019, the corporate security landscape goes beyond basics to keeps employees informed and safe.

Emergency preparedness is becoming more complex for businesses as technology, communication, and society continues to evolve. There is plenty of buzz surrounding safety solutions, and it can be tricky to cut through the noise. Discover top industry trends and gain actionable insights from subject matter expects at Rave Summit. Join Rave Mobile Safety, our partners, customers, and specialists as they help security professionals and industry peers learn the latest tricks, tips, and best practices in the evolving world public safety at #RaveSummit. Click here to learn more and register by January 31 to save 45% off registration!

Healthcare facilities find it harder to defend against active shooter threats than other soft targets because shooters in healthcare environments often have more personal targets and an apparently lawful purpose for entering the facility. The issue can be further complicated by healthcare providers remaining with vulnerable and elderly patients, and placing themselves at risk of injury.

Most active shooter events are impersonal in nature. Some - such as the Mandalay Bay shooting in Las Vegas last fall - are totally indiscriminate, while others - such as the recent Kroger grocery store shooting in Kentucky - are motivated by the hatred of a group of people due to their race, religious beliefs, or sexuality. Rarely is an active shooter motivated by the desire to kill or injure a person known to them.

The exception to this “rule” is active shooter events in healthcare environments. These can be both impersonal and personal in nature, and are commonly motivated by personal grudges, euthanizing an ill relative, or suicide. In many cases, the perpetrator had a lawful purpose for entering the facilities and would have passed ID checks to visit personnel, ill relatives, or physicians. Examples include:

• In November 2018, Juan Lopez entered the Mercy Hospital in Chicago on the premise of wanting to see his former fiancé Dr. Tamara O´Neal. Lopez started an argument with O´Neal, which concluded with four deaths - Lopez, O´Neal, a pharmaceutical resident, and a police officer.
• In August 2018, Richard DeLucia entered the Westchester Medical Center in New York to visit his terminally ill wife, Anne. DeLucia killed his wife before turning his gun on himself. Police later found a note at the couple´s home stating DeLucia wanted to end his wife´s suffering.
• In November 2010, John Jack - a former employee of the Palm Bay Hospital in Florida - turned up at the hospital ostensibly to say goodbye to his former colleagues. Although having no grudge against his former employer, Jack went into a back office and killed himself.

Metal Detectors and Armed Guards are Not the Answer

The installation of metal detectors at healthcare facilities does not necessarily stop active shooters. There has been a history of active shooters using guards´ guns to attempt an escape from Emergency Departments while in custody or while detained as a psychiatric patient. Research conducted in 2012 found that, of thirty shooting incidents in Emergency Departments between 200 and 2011, half were committed with a guard´s gun, while five other in-hospital events were also committed with a gun taken from a guard or other security personnel.

For this reason, many healthcare facilities are reluctant to arm guards with any form of weapon - especially as nursing staff feel compelled to remain with vulnerable and elderly patients rather than follow the recommended course of action in an active shooter scenario of run, hide, or fight. Instead, healthcare facilities are using technology to mitigate the potential consequences of an active shooter on their premises and give nursing staff as much warning as possible about the risk of danger.

Mitigating Potential Consequences with a Multifaceted Crisis Communications Platform

One of the technologies being implemented to help healthcare facilities communicate with employees during an emergency is a mass notification system. Having a system that would allow hospitals and healthcare facilities to communicate with all of their personnel, whether they’re on-site, working in the field or traveling to different locations, is vital so they can continue business operations, especially during an emergency. A multifaceted crisis communications platform would allow you to have two-way communications over multiple channels with all of your healthcare staff wherever they’re located, such as at the hospital, another part of campus or in a patient’s home. It would help you respond to your healthcare staff’s needs, offer them guidance and keep them safe.

If an incident occurs and you need to know about the safety and security of your traveling nurses, in-home caregivers and others, you can send out a poll to collect real-time location data of your traveling employees. A poll-based alerting system that’s integrated with your organization-wide mass notification platform allows you to gather poll responses and real-time location data from a select group of your workers through text and email. Through polling, your traveling healthcare staff employees can answer a question through email or a SMS text, automatically sharing their real-time locations. For example, if an adverse event occurs and you want to check on your staff, a poll can be sent out for a status update. Automatic follow-up alerts then can be sent out based on your traveling healthcare staff’s response and outline the necessary next steps.

Another way to empower your healthcare personnel to be ready for any situation is through an employee safety app. An employee safety app would help them if they need to act in an emergency or dangerous situation, while strengthening your connection with your staff. RNs, LPNs, personal healthcare aides and others would be instantly connected
to your emergency managers and other staff, so they can inform your safety and security personnel about what’s going on. Emergency procedures then could begin quicker. An employee safety app also would include an emergency call button, as well as the ability for
your healthcare staff to travel with a virtual escort and you to send targeted notifications.

Our top 5 workplace violence blogs reveals common themes running throughout. Typically, these are attributable to a lack of employee engagement, which can be understandable if the systems in place to enhance the safety of employees are not ideal for the environment or are being fully utilized.

The level of workplace violence in the United States is a difficult subject to quantify because of how it is defined. Whereas many people would consider the term “workplace violence” to cover acts of physical aggression in the workplace in which physical harm is suffered, the OSHA definition includes threats of physical aggression, any type of harassment, verbal abuse, and even passive aggression.

Consequently there is a wide disparity in workplace violence statistics due many business failing to comply with OSHA reporting regulations. Some of this disparity is attributable to businesses and employees not fully understanding OSHA's definition of workplace violence; but, as was revealed in our “Latest Workplace Violence Statistics” blog, there are significant discrepancies between the number of injuries reported to OSHA and the number of workers' compensation claims made each year.

Employers Have a Duty of Care towards Remote Workers

Furthermore, the duty of care to protect employees from violence in the workplace is not confined to any specific physical environment. Remote workers and lone workers should be given the same level of protection against violence as an employee engaged in an office or factory - particularly in the healthcare industry which suffers a higher reported incidence of workplace violence than any other.

A solution to keeping a pulse on employee wellness at all times was discussed in our “Business Continuity Management Tool” blog, along with recommendations about how the tool could be used to provide real-time employee location data, accurate employee status updates, and smarter communication for lone workers with it being necessary for employees to downloads apps.

Overcoming Communication Roadblocks for Critical Messages

Both on-site and off-site employees are subject to an ongoing barrage of communication “noise”, and this can prevent critical messages from getting through - a serious issue if an active shooter is on the premises or in the vicinity. Shootings accounted for 394 of 500 workplace homicides in 2016 and many communication systems are inadequate for warning employees of danger in an appropriate timeframe.

A comparison of communication systems and their effectiveness at alerting employees to the risk of danger was the subject of our “Notification System Tools” blog. The blog's conclusion was that a multi-modal communication system was the ideal solution for both emergency alerts and non-emergency communications - particularly one that encourages employee engagement.

Making Full Use of the Communication System in Place

Making full use of the communication system in place to support employee safety was a subject discussed in our blog “Four Questions to Ask Before Renewing Your Mass Notification Contract”. In the blog it was mentioned that a vendor should help businesses identify weaknesses in mass notification strategies and underutilized capabilities of the system that could help it reach its full potential.

It was also mentioned that businesses should not refrain from providing feedback if the communication system in place is not entirely appropriate for their environment. Vendors thrive on challenges to produce more effective and innovative solutions, and for this reason it is a good idea for businesses to seek employee feedback about the systems in place to protect them from workplace violence.

Delivering Faster Resolutions to Business Challenges

The final of our top 5 workplace blogs discusses “Overcoming 5 Business Communication Challenges”. It summarizes everything that has been mentioned above - rising above communication “noise”, proactively communicating, connecting with remote and lone workers, and receiving actionable feedback - plus adds using mass notification tools to deliver faster resolutions to business challenges.

The solutions suggested to overcome the business challenges and deliver faster resolutions include Rave Alert and Rave Guardian - two user-friendly multi-modal mass notification tools that include geo-polling capabilities to better engage employees and connect with off-site workers. The two tools encourage actionable feedback through two-way communication; which, in an emergency, can enhance situational awareness to deliver faster resolutions and minimize business disruption.

Today, Rave announced the acquisition of SwiftReach Networks (SwiftReach), creating the largest and most robust voice-calling capacity in the emergency notification industry. This offers an end-to-end safety suite for K-12 schools across the country and will provide wide-ranging capabilities and unmatched infrastructure to ensure optimal communications when it matters most. 

A Look Back Through Rave's History

We recently took a trip back through the 14 years of Rave's history for our 14th anniversary to reminisce on how far we've come. What started in 2004 as a company that leveraged carrier-based location services, has made its way through the higher ed, public safety, k-12 education, and enterprise markets to deliver a variety of emergency notification services. The acquisition of SwiftReach will mark a new milestone in Rave's history and will expand delivery capacity and reliability.

Rave's CEO, Todd Piett, had this to say about this important part of Rave's history:

The addition of SwiftReach and its FCC-licensed carrier class network gives us best-in-class message delivery, which provides customers with unmatched service levels. Rave is most needed by our customers during emergencies and we continue to protect them by leading the way in reliability.

It allows the company to maintain its commitment to excellence and in making sure our customers are successful. This is a common thread for both Rave and SwiftReach with Todd Miller, Rave’s COO, noting: “It’s extremely important that we maintain focus on our customers and their success. The SwiftReach team has demonstrated that commitment for many years, and we look forward to continuing to keep customer success our first priority.” 

What's Next for the New Rave

Not only will the acquisition of SwiftReach bring the only emergency and mass notification provider that owns and operates its own telephony network, the new entity will bring a complete K-12 school safety communication solution. SwiftReach’s SwiftK12™ will be a nice addition to Rave's existing school safety offerings. The combined suite of products will enable users to engage parents through emergency alerts, solicit anonymous tips with Rave EyeWitness and improve collaboration with 9-1-1 and emergency services utilizing the Rave Panic Button.  

If you would like to stay in the loop with all of Rave's happenings, make sure to subscribe to our monthly newsletter.

Red collar crime is a sub-group of white collar crime in which the perpetrator uses violence to avoid detection or prosecution. Although red collar crime appears to be a rare event in the U.S., this is not necessarily the case, and it is advisable for businesses to have a process through which white collar crime can be reported anonymously.

The term “white collar crime” is usually identified with financially motivated, non-violent crimes committed by employees against their employer, or by individuals against a financial institution. The crimes typically consist of forgery, insider trading, fraud, or embezzlement, and were estimated by the FBI in 2016 to cost U.S. business more than $500 billion per year.

Nobody really knows the true cost of white collar crimes because not all white collar crimes are detected. Furthermore, when they are, only 58% of white collar crimes are reported to law enforcement agencies according to the Association of Certified Fraud Examiners (PDF), who also claims businesses on average lose 5% of their revenue each year due to forgery, insider trading, fraud, or embezzlement.

When White Collar Crime Turns Red

When white collar crimes are detected, the most common outcome is an admission of guilt and - depending on the nature and severity of the crime - a custodial sentence, a financial settlement, or disciplinary action. However, when the perpetrator doesn't want the nature of his actions disclosed, the outcome can be much different.

Around fifty recorded cases have occurred in the past thirty years in which the perpetrator has either murdered the person who discovered their crime, or paid somebody else to do it. Many of these cases were reviewed by Frank Perri - a criminal psychologist at the DePaul University in Chicago - to develop psychological profiles of offenders who commit red collar crimes.

Perri's results were published in the International Journal of Psychological Studies in 2016, and they make fascinating reading. His review of the cases found red collar criminals typically harbor behavioral risk factors that lead them to use violence as a solution to a perceived problem, in the same way as non-white-collar offenders resort to violence.

Examples of Red Collar Crime in the Workplace

One of the earliest examples of recorded red collar crime in the workplace dates back to 1982, when the owner of the Candor Diamond Company of Manhattan - Irwin Margolies - contracted a hitman to kill two employees. The first he suspected of alerting federal prosecutors to his multimillion dollar fraud, and the second was due to testify against him - even though she had benefitted from the fraud herself.

In the workplace, red collar crime does not necessarily result in the murder - or attempted murder - of a colleague. In 2008, Sallie Rohrbach, an agency examiner with the North Carolina Department of Insurance, was murdered by insurance company owner Michael Howell after she discovered evidence of insurance fraud. In this case, Sallie was a lone worker at risk rather than a colleague.

More recently in 2016, a former bank employee - Naquan Reyes - was convicted of paying for the murder of a co-conspirator, who had been caught conducting check fraud on Reyes' behalf and who had agreed to testify against him. Although not a colleague-on-colleague red colleague crime, other co-conspirators had worked in the bank with Reyes and were equally as guilty in the check fraud scam.

The Extent of Red Collar Crime is Unknown

In the same way as nobody really knows the true cost of white collar crimes, the extent of red collar crime is also unknown. There could be many dozens more murders attributable to the cover-up of white collar crime; but, because the white collar crime has remained undetected, the connection is never made. Conversely, a murder could go undetected when a white collar crime have been discovered.

There have been a number of failed red collar crimes - for example, in 2008, Randy Nowak was found guilty of attempting to hire a hitman to murder an IRS agent he believed was about to uncover his tax fraud and money laundering schemes. Unfortunately for Nowak, the hitman he tried to hire was an undercover FBI agent who subsequently turned him in.

Sometimes white collar criminals turn on white collar criminals, as was the case when Scott Kimball ratted on cellmates Arnold Flowers and Sompong Khamsomphou who had been incarcerated awaiting trial for check fraud. Kimball - who was also accused of check fraud - alleged Flowers had asked him to hire a hitman to kill U.S. District Judge Russel Holland, U.S. Attorney Crandon Randell and two witnesses. Due to Kimball being an unreliable witness, the charges were later reduced to witness tampering.

How to Prevent Red Collar Crime

The best way to prevent white collar crime - and therefore by association red collar crime - is for businesses to have a process through which white collar crime can be reported anonymously. According to the Association of Certified Fraud Examiners, 40% of white collar crime is detected by tips, and this figure rises to 46% when businesses have a hotline or other service assigned for receiving tips.

Implementing an anonymous tip service has more financial benefits than just alerting security personnel to internal fraud. The Association of Certified Fraud Examiners found that losses attributable to white collar crime were 50% smaller for businesses with a tip service, and also that these businesses were less exposed to fines for regulatory non-compliance because they had controls in place to prevent fraud.

For businesses that do not yet have an anonymous tip service in place, another potential solution is an employee safety app. The app supports two-way anonymous tip texting, and has personal safety features such as the virtual escort that can help protect lone workers - such as Sallie Rohrbach. The app can also be integrated with other mass notification services to warn employees of dangerous situations in advance.

Staffing in healthcare is such a complex topic that a proposal to limit the number of patients assigned to nurses was recently included on the Massachusetts ballot. The proposal was ultimately defeated, but at least it started a dialogue about the needs of patient populations and addressing staffing in healthcare.

The defeat of the Nurse Staffing Proposal in Massachusetts was welcomed by several industry bodies - not least the American Nursing Association (ANA), who issued a statement saying the one size fits all proposal failed to acknowledge the complexities of nurse staffing. The ANA said it would work with hospital leaders and the unions that brought the initiative to “identify a constructive path forward to develop shared solutions”.

To the casual observer, it might appear unusual that an organization dedicated to protecting the nursing profession is opposed to fixed patient-to-nurse ratios. However, the ANA is keen to point out there is a distinct difference between scheduling (predetermining a set number of nurses based on historical numbers and anticipated volumes) and staffing - which rarely looks beyond the next 24 hours to ensure the right nurses are in the right place at the right time.

Why is Staffing in Healthcare Such a Complex Topic?

Discussing the complexity of staffing in healthcare, the ANA states “appropriate nurse staffing …is achieved by dynamic, multifaceted decision making processes that must take into account a wide range of variables.” Addressing staffing in healthcare is made more complex by up to three staffing models being used simultaneously in healthcare facilities:

• The budget-based model, in which nursing staff are allocated according to nursing hours per patient day.
• The patient-to-nurse ratio model - which can be mandated by state law universally or for specific units.
• The patient acuity model, in which the needs of patient populations determine each shift's staffing requirement.

The patient acuity model is the most dynamic. Not all patients with the same disease or injury have the same needs, and factors such as the severity of an illness and the patient's ability to provide self-care can change staffing requirements at short notice. Further complexities exist during and after an emergency incident - such as a severe weather event - when the number of patients and the nature of their illnesses and injuries can vary dramatically.

Software Solutions for Addressing Staffing in Healthcare

Software solutions for addressing staffing in healthcare already exist. Typically these consist of mass notification systems that have geo-poll capabilities. Geo-polls work by sending a message to a database of contacts in the format of a question with a selection of answers. In the context of addressing staffing in healthcare, the Q&A may look like this:

Q: Looking to cover two early RN shifts in the Oncology Unit. Are you available?
A1: Yes
A2: No

Nursing staff receive the message on their mobile devices by SMS text, voice broadcast, and email. They respond by pressing keys on the keypad (no apps are required), and their answers are sent back to the web-based notification console. Once the required number of shifts has been filled, the poll automatically closes so that nursing staff are aware the shifts have been covered and unit managers are not spending time dealing with unnecessary responses.

One of the benefits of geo-polls is that personnel databases can be segmented by role, location, or other attribute. Consequently, if a unit manager required two RNs, the geo-poll could be send to only RNs and not the entire personnel database. This has benefits in all nature of notification events, such as severe weather blocking roads in certain locations, evacuation orders being sent to all on-site personnel, and checking on the wellbeing of nursing staff working in the community.

5 Best Practices for Addressing Staffing in Healthcare

Maximizing the benefit of a mass notification tool with geo-poll capabilities involves five best practices unit managers should employ - whether the solution is used exclusively for addressing staffing in healthcare or integrated into the communications element of an Emergency Preparedness Plan. These best practices can accelerate the speed at which polls and emergency notifications are sent, and the speed with which responses are received.

1. Prepare Templates for Different Situations

Staffing requirements will undoubtedly change with every vacant shift, but it can help to have templates already created to save time writing new messages every time there is a staffing shortage. Templates are essential if a healthcare facility is intending to use the notification tool to alert personnel to emergencies so they are clearly written at a time when managers will not be stressed or in danger.

2. Plan Reactions to Different Responses

Managers need to plan ahead for the different responses they receive. What if there are not sufficient positive responses to fill vacant shifts? What if personnel need assistance getting to a healthcare facility during a severe weather event? What if a message checking on the wellbeing of a community nurse goes unanswered? There needs to be a contingency plan for every use of a geo-poll message.

3. Explain the Importance of Replying

It can sometimes be sufficient to notify personnel they will be receiving geo-polls, wellness checks, and/or emergency notifications via their mobile devices, but it is advisable to educate nurses on the importance of replying to a message of any nature, even if they are unable to fill a shift, are safe in the community or are unaffected by the emergency in order to save time with follow-up messages.

4. Practice Dry Runs for Multiple Scenarios

Practicing dry runs for all the scenarios in which the geo-poll capability will be used will familiarize unit managers with using the notification portal and nursing personnel with receiving messages on their mobile devices and responding to them. A secondary best practice in this section is to have nursing personnel assign different ringtones for incoming messages to mitigate the risk of alert fatigue.

5. Keep the Personnel Database Up-to-Date

It is essential that personnel databases are kept up-to-date to avoid scenarios in which personnel are not reachable. Ongoing freshness checks with HR databases can ensure only current nursing staff are on the polling and notification lists, while nursing personnel should also ensure they advise HR of any changes to their mobile device numbers. Forgetting to do so could cost them their lives.

Find Out More about Polling for Addressing Staffing in Healthcare

The most important responsibility for healthcare facilities is maintaining a continuity of operations every day, especially during a public health emergency or a disaster. Having adequate nursing personnel during and after these events is critical to meet increased medical demands, yet many organizations struggle with addressing staffing in healthcare - while software solutions that can help overcome this issue quickly and cost-effectively.

Businesses are becoming increasingly aware of the risks faced by traveling workers and are providing a mobile worker safety solution. However, not all solutions are equally as effective at protecting traveling workers from the risks they may encounter, or for best ensuring their safety while in transit.

There are traveling workers (or “mobile workers”) in practically every industry - from computer technicians who travel from client to client, to realtors who show homebuyers around prospective properties. Regardless of which industry they work in, mobile workers are exposed to health and safety risks that do not exist in a static environment.

In some states, occupational safety legislation exist that require businesses to consider the health and safety of mobile workers. Some insurance plans offer discounts when businesses provide a mobile worker safety solution. But often, these solutions are not fully effective at ensuring their safety or providing a rapid response when necessary.

Mobile Worker Risks that Do Not Exist in a Static Environment

The risks faced by mobile workers can vary according to whether they travel short distances domestically, or travel vast distances overseas; but they generally fall into four categories: the public, the environment, slips, trips and falls, and other accidents or illnesses.

Public

The public category contains some of the most dangerous threats to mobile worker safety - especially for mobile workers with disabilities, or mobile workers carrying cash, high value goods, or medical supplies as part of their work. These workers can be subject to theft, assault, unprovoked attack, or simply being in the wrong place at the wrong time in the event of a terrorist attack or shooting incident.

Environment

The environment category includes severe weather events, hostile animals, and dangerous or unhygienic conditions. These threats can be exacerbated when a mobile worker is traveling or working in an environment they are unfamiliar with, or when the nature of the risk is beyond any training they have received. In these circumstances, an effective mobile worker safety solution is essential.

Slips, Trips, and Falls

According to OSHA, slips, trips, and falls account for the majority of general industry accidents and are the second leading cause of all accidental deaths behind motor vehicle accidents. When an employee slips, trips, or falls, in a static workplace, there is usually a colleague to help them or call for assistance. Mobile workers often work alone and have to seek help independently - if they are able to.

Other Accidents or Illnesses

The category of other accidents or illnesses covers any type of in-transit event (including motor vehicle accidents) and illnesses that a mobile worker may not initially acknowledge as an illness until it develops into something more serious. This can be a life-threatening issue if it happens overseas, in a remote area with limited medical coverage, or if the mobile worker is working alone in an unfamiliar environment.

What to Look for in a Mobile Worker Safety Solution

A reliable and effective mobile worker safety solution ideally would be a personal safety app that connects mobile workers with their security team and 9-1-1 when an emergency occurs. In addition to a call directory for easy-to-find assistance and a content portal for on-the-go resources, the app contains two key features to enhance mobile worker safety.

The first is a safety timer that mobile workers can set as they leave to visit a client. The safety timer records the departure point and the destination point, and counts down to zero while the mobile worker is traveling. If the timer reaches zero and is not deactivated by the mobile worker, an alert is sent to the business, which can then be followed up by 9-1-1 or by colleagues in the area.

The second feature is geo-targeted push notifications. Businesses can use this feature to “check in” with a mobile worker periodically, or to send alerts relating to severe weather, travel disruption, or other dangerous event (i.e. active shooter event). Due to the app's geo-tagged location tracking software, if a mobile worker does not respond to the push notification, businesses know where to send help.

Ultimately, Health and Safety officials, emergency preparedness managers, and HR directors should look for a personal safety app that would enable their mobile workers to stay connected with their organization's safety and security personnel and empower them to prioritize their personal safety while at work. 

Phishing is the primary method for distributing malware, viruses, and ransomware, and for conducting Business Email Compromise (BEC) attacks. Depending on whose research you read (and considering many phishing attacks are unreported), the average cost of a successful phishing attack can be anything from three million to ten million dollars for a large company.

The difficulty in defending against phishing attacks is that phishing emails are designed to appeal to employees' senses of fear, sympathy, curiosity, or greed. Different employees are susceptible to different emotions and, due to most phishing emails demanding urgent action, the consequences of an acted-upon phishing email usually manifest quickly - making it difficult to mitigate their effect.

The Two Main Types of Phishing Email

The two main types of phishing email are scatter phishing and spear phishing - scatter phishing being when the same scam emails are distributed widely, whereas spear phishing emails are targeted at one specific individual. Of the two types, scatter phishing is easier to detect because multiple employees are unlikely to have the same triggers that make them susceptible to phishing and - hopefully - an employee will report the phishing attack to the company's IT Security Team.

The second type - spear phishing - is harder to detect because phishing emails are sent individually and crafted to appeal to an employee's specific emotional triggers. This is often achieved through “social engineering” - the practice of researching an individual through their social media accounts or other publicly-available data to guesstimate how they will respond to fear, sympathy, curiosity, or greed. The consequences either type of phishing attack can be devastating, but they can also be mitigated.

Mitigating the Consequences of a Phishing Attack

Based on the above descriptions of phishing emails, there are four possible scenarios:

• A scatter email is detected and reported to IT.
• A scatter email is opened, acted upon, and then reported to IT.
• A spear phishing email is detected and reported to IT.
• A spear phishing email is opened, acted upon, and then reported to IT.

Regardless of the whether an email has been opened and acted upon or not, it is important for all employees to be made aware quickly that the company is being targeted by cybercriminals. If a scatter email has evaded detection by network security defenses, employees need to know who it purports to come from so they can quarantine it as soon as it arrives in their inboxes. If one has been opened and acted upon in error, fast action could prevent the consequences being exacerbated.

If a cybercriminal has taken control of an employee's email account - either through scatter phishing or spear phishing - this information needs to be shared immediately to prevent other employees opening emails from the compromised account. The compromised account should also be taken offline in order to prevent emails from a supposed “trusted sender” being delivered to third party businesses - which could then cause reputational damage if “trusted” emails are opened and acted upon.

The Fastest Way to Alert Employees to a Phishing Attack

The fastest way to alert employees to a phishing attack is through mass SMS texting. An alert sent simultaneously to every employee's mobile device will undoubtedly attract attention - even if individual employees have their mobile devices switched to silent - and will result in employees taking notice of the alert's warning. The text should not only advise employees to quarantine the phishing emails that have been detected, but also warn them about opening any emails and acting upon them.

Sometimes covering all the information necessary in one SMS text is difficult due to the number of characters allowed in a single text alert. Therefore, a more suitable solution is a mass notification platform that can be used to send character-limited alerts to employees via SMS text and more detailed information via email. This would also prompt employees to review their inboxes in order to identify further suspicious emails that should be reported to the company's IT Security Team.

Using Mass Notification to Conduct Phishing Simulation Exercises

One of the best ways to defend networks against phishing emails is to condition employees against phishing via simulation exercises. In these exercises, employees are sent fake phishing emails to see whether they are detected or not. The fake emails are then followed up by an alert poll to find out who detected the emails were fake and how they reacted to them. A typical Q&A alert poll might consist of the following options for employees to select an answer:

Q: Did you receive an email entitled “Your Account Subscription” from ABC Enterprises?

A1: No.

A2: Yes, and it didn't apply to me so I deleted it.

A3: Yes, and I thought it was a scam so I quarantined it.

A4: Yes, I opened it and then reported it.

A5: Yes, I opened it and clicked on the link but nothing happened.

The feedback from this type of phishing simulation exercise will give companies a better understanding of which employees are susceptible to phishing emails and how they are likely to react to them. The exercise should be repeated at irregular intervals to test employees' susceptibility to different emotional triggers, as one exercise alone may not prove to be effective. Once the feedback from several exercises has been analyzed, companies will be able to address areas where they are most at risk from phishing.

According to the Center for Disease Control, one in every four women and one in every ten men will experience domestic violence in their lifetime. Physical and mental abuse at the hands of an intimate partner affects every aspect of the victim’s life, including the ability to work. According to Legal Momentum, victims of domestic violence lose about 137 hours of work per year, and causes victims to lose the equivalent of 32,000 full-time jobs per year. The Department of Labor reports similar statistics, with victims losing 8 million hours of work per year.

The pervasiveness of domestic violence in the United States means that employers, human resource officers, and workplace safety manager have a responsibility to help victims. According to the Society for Human Resource Management, 65% of companies do not have formal workplace violence prevention policy. The survey also found that only 20% of companies offered a training on domestic violence. There are many ways that employers can do better to protect employees who may be struggling with domestic or partner violence in the workplace or in their personal lives.

Given the prevalence of this issue, it’s important to have an employee policy that provides protections for victims of domestic violence. These include mandates that would keep employees safe at work, keep their job, help them get time off to go to court or recover from injuries sustained from domestic abuse. If these rules are written into the employee manual, it can be a resource for anyone who might be struggling. It’s also important to post these policies in the workplace, and make human resources available to employees who might be struggling with a difficult situation. In many instances, employees might be concerned about work performance or losing their jobs, which can be mitigated by keeping lines of communication open.

How to Address Domestic Violence in the Workplace

The first step to addressing domestic violence in the workplace is to acknowledge the issue. While employers may not believe that domestic violence can impact the workplace, the issue does not have bounds. For victims, the violence can impact every element of their life. Once a company realizes that the workplace has a responsibility to address this issue, it might worry managers that the infrastructure is not equipped to handle issues of this kind.

In an interview with SHRM, Kim Wells, executive director of the Corporate Alliance to End Partner Violence said that employers don’t have to be experts to help. “Once employers understand that domestic violence can impact their workplace, their next fear is that they’re not equipped to address the issue. And that’s true, but they’re not expected to be experts,” Wells said. “While we want managers and supervisors and co-workers to be trained about domestic violence and its impact on the workplace, and how to respond and get people to the help they need, we do not want them to take on a role that should be filled by those professionally trained to help.”

Once a company has decided what role to take on in addressing domestic violence, they can craft a response program that hires professional help for employees who are victims. A well crafted response plan will include several steps that accommodate employees who are victims, whether it is addressing a workplace issue or providing support. These plans don't mean that human resource steams need to directly tackle these issues, but rather provide the correct tools and guidance to keep employees safe.

Leveraging Technology to Help Domestic Violence Victims 

While managers might be reluctant to discuss something that affects people’s personal lives, it's crucial for company safety to include a protocol for domestic violence situations. Technology can play a major role in helping HR provide outreach and help for victims, beginning with an anonymous 2-way tip texting system. This tool allows employees to communicate safety concerns, whether it involves workplace violence or violence experienced outside the office, without compromising their own safety. If a fellow employee is concerned for a coworkers safety, this also provides an avenue to help this person get help without jeopardizing the workplace relationship. In many of these scenarios, victims are especially likely to be hesitant to reach out, and a two-way tip texting tool can be an important communication solution for safety managers. 

If an employee is not able to manage their safety outside of the office, there is a risk that the violence in the home can be brought into the workplace. If an abusive spouse or significant other enters a workplace, a workplace safety app allows employees to either contact 9-1-1 directly or alert safety managers so that they may respond to the incident accordingly.  This way, local law enforcement can arrive on the scene faster with the correct information about the threat. Not only will the workplace be better equipped to protect the employee experiencing domestic violence, it will also improve the safety of the company community as a whole. 

There is no denying that severe weather events are increasing both in number and in the damage they cause; and that emergency managers are placed under significant stress. If you’re attending the National Healthcare Coalition Preparedness Conference in New Orleans later on this month, stop by booth # 5 to talk about preparedness.

Not only do healthcare facilities have the responsibility for the safety of patients in their care and staff when storms, hurricanes, and tornadoes land, they may also have to cope with a large influx of patients who have sustained weather-related injuries. Similarly, community emergency managers have the responsibility of making sure vulnerable citizens are also safe, especially if they can’t evacuate by themselves.

Thereafter, there is what is known as the “ripple effect” - an increase in hospital admissions attributable to the exacerbation of chronic diseases caused by medications being left behind during the rush to evacuate, a loss of power to operate home medical devices such as ventilators, or the closure of pharmacies. The ripple effect can be responsible for as many hospital admissions as weather-related injuries, and can last for months after a severe weather event due to longer hospital stays.

How do Communities Prepare their Healthcare Facilities for Severe Weather Events?

All healthcare facilities participating in the Medicare and Medicaid programs are required by law to have an all-hazards Emergency Preparedness Plan - along with a Communications Plan - and policies and procedures for testing and executing the plan. It is also necessary for healthcare facilities accredited by the Joint Commission to have an all-hazards Emergency Operations Plan that covers communications, resources and assets, safety and security, staff responsibilities, utilities, and clinical support activities.

The term “all-hazards” is not defined in either the CMS' Emergency Preparedness Rule or the Joint Commission's accreditation guidelines, and it is left to each healthcare facility to conduct a risk assessment to determine what hazards it may be subject to and susceptible to. Consequently there is no “one-size-fits-all” methodology for preparing for severe weather events, or indeed for any particular type of emergency (fire, active shooter, hazardous material incident, etc.).

Do Emergency Preparedness Perceptions Differ from Reality?

That would appear to be the case according to our “Emergency Preparedness and Security Trends in Healthcare Report” in which we surveyed hundreds of healthcare leaders about their perceived safety concerns and the actual events that have taken place at their facilities over the past two years. Although severe weather events ranked high in both the safety concerns and actual events categories, this did not reflect in the frequency with which severe weather emergency plans are tested.

A likely reason for this is that CMS and the Joint Commission require healthcare facilities to conduct at least two emergency preparedness exercises per year, while most state fire codes require healthcare facilities to conduct a minimum of two (and sometimes four) fire drills each year. Therefore, provided fires are included as a potential hazard in a healthcare facility's risk assessment, the healthcare facility is fulfilling its Emergency Preparedness requirements by conducting state-mandated fire drills.

Resolving Communication Issues is Key to Preparedness

Healthcare Facilities

When an emergency incident occurs, speed is of the essence. A minute's delay in alerting staff to the risk of danger can cost lives. Similarly, when staff, medication, and supplies are in short supply, healthcare leaders need fast information about where the shortages exist and how soon replacement staff, medication, and supplies can be organized. If communication issues exist in any of these areas, the consequences could be significant for both staff and patients.

A mass notification platform is an ideal solution for resolving potential communication issues. It not only provides a means of simultaneously alerting staff to the risk of danger via multiple channels of communication, but supports two-way communication to enhance situational awareness, has a geo-poll capability to facilitate quick answers to critical questions, and allows the segmentation of contacts according to role, location, or other attribute.

• By alerting staff to a severe weather event via multiple channels of communication, the reach of the alert is extended to the maximum possible.
• Two-way communication ensures hospital administrators are kept up-to-date with all the information they need to effectively manage the emergency via one portal.
• Geo-polls provide the opportunity to quickly obtain information about staff availability, the accessibility of medication and supplies, and capacity in other healthcare facilities.
• The segmentation of contacts enables hospital administrators to alert only those for whom incidents are relevant, thus minimizing disruption in the rest of the healthcare facility.

Overall Community Preparedness

Another critical component to overall community preparedness is ensuring that anyone with vulnerable needs and without access to a healthcare facility is accounted for and is provided resources. Maintaining an online vulnerable needs registry is one way to identify community members who might need assistance during a severe weather event. This would help emergency members make sure that the right resources are in the right place to help the right people at the right time, including coordinating with healthcare facilities.

Let's Continue the Conversation

Meet us at booth # 5 at the National Healthcare Coalition Preparedness Conference in New Orleans and let's continue discussing how to prepare our healthcare facilities and communities for severe weather events. Take a look at the findings from our latest survey on healthcare preparedness trends and let us know what you think.

Every year, between 5 and 20 percent of the population gets the flu. For businesses, losing between 5 percent and 20 percent of a workforce for an average of three days is expensive, making the need to communicate outbreaks critical. The U.S. Department of Labor has estimated the annual cost of flu-related absenteeism to be nearly $20 billion; but absenteeism may not be the biggest flu-related problem businesses have to manage.

A potentially bigger problem is “presenteeism” - employees turning up for work with the flu, and consequently underperforming while sharing the infection with work colleagues. Not only does this increase the rate of flu-related absenteeism throughout the business, but employees turning up for work when they are ill generally take longer to recover and often end up taking time off anyway.

Where presenteeism can be become a serious problem is when flu infections spread to employees with a high risk of complications. The high-risk group includes older employees, pregnant employees, and employees with medical conditions such as asthma, diabetes, and metabolic disorders. If high-risk employees contract the flu, and then develop complications, the outcome can be fatal.

Best Practices for Preventing Flu Outbreaks in the Workplace

The best practices for preventing flu outbreaks in the workplace include encouraging flu vaccinations, maintaining good air quality in the office environment, and discouraging employees from turning up to work when they feel unwell. In order to support the third of these best practices, businesses should develop policies relating to sick leave, the transfer of duties, and what to do if feeling unwell while traveling to the workplace - and distribute these policies to all employees.

When an employee arrives at the workplace displaying symptoms of flu - or develops the symptoms of flu while working - they should be sent home. However, removing an infected employee from the environment may not necessarily prevent a flu outbreak. Flu particles can remain suspended in the air for up to an hour (which is why maintaining good air quality is so important) and, in droplet form (i.e. from sneezes and coughs over desks and office furniture), can remain active for up to three hours.

Naturally, after an employee has been sent home due to displaying symptoms of flu, their immediate environment should be sanitized. However, without knowing the employee's exact movements since their arrival, flu particles may still remain in the air or in droplet form on office furniture - presenting a risk that work colleagues might still become infected. This is of particular concern when employees with a high-risk of complications are in danger of contracting the flu.

Alerting Employees to Outbreaks of Flu in the Workplace

Whereas email may be an appropriate channel of communication for distributing information about flu vaccinations and flu-related HR policies, it is not ideal for alerting employees to short-term dangers. The threat from flu droplets may have completely receded before an employee reads their emails, by which time it may be too late for the employee to avoid exposure to the infection. Consequently a better solution than email is required for alerting employees to outbreaks of flu in the workplace.

One such solution is a mass notification platform that can alert thousands of employees simultaneously to the risk of danger using multiple channels of communication (SMS text, social media, voice broadcast, etc.). It is an ideal solution for alerting employees to outbreaks of flu in the workplace quickly, as it only takes a few clicks of a mouse to advise employees to keep clear of a potentially infected area, and then inform them when it should be safe to enter the area again.

Using a mass notification system in this manner is also a good way of publicizing that a “send home” policy is being enforced. It will help further discourage employees from turning up from work when they feel unwell - not just when they are suffering from flu, but from all illnesses - thus reducing presenteeism and the costs associated with it. 

On November 6th, citizens of Massachusetts will vote on a nurse staffing proposal limiting the number of patients assigned to a nurse depending on the type of patient and the patient's condition. Supporters of the proposal claim it will increase safety and improve patient outcomes. Opponents disagree.

In 2017, the Massachusetts Nurses Association created a ballot campaign committee - the Committee to Ensure Safe Patient Care - with the objective of setting a limit to the number of patients assigned to one nurse at a time. The Association claims unsafe patient assignments in healthcare facilities are responsible for higher rates of readmission, medication errors, and patient deaths, and is campaigning in favor of a Patient Safety Act (PDF) that would enforce patient limits throughout the state.

The Association is supporting its campaign for safe patient assignments with the results of a survey conducted earlier this year among nurses registered with the Massachusetts Board of Registration in Nursing. The survey - “The State of Patient Care” - reveals that patient safety concerns among nurses (fewer than half of which were members of the Association) have increased significantly compared to a similar survey conducted in 2014. Among some of the key statistics reported include:

• 64% of respondents reported an incident of patient injury due to unsafe patient assignments - up from 46% in 2014.
• 77% of respondents reported a patient medication error attributable to understaffing - up from 57% in 2014.
• 66% of respondents reported patients were staying longer in hospitals (from 51%), while 72% reported an increased number of re-admissions (from 56%).
• The increased number of re-admissions (according to 86% of respondents) is due to nurses not having the time to educate patients and provide adequate discharge planning.
• 77% of Massachusetts nurses said they were assigned too many patients to care for at one time, while 36% reported patient deaths directly attributable to understaffing.

This is not the first time the Massachusetts Nurses Association has campaigned for limits to be applied to patient assignments. In 2014, the Association campaigned for a similar proposal, but agreed to withdraw its campaign after a compromise was reached setting a two-patient limit for nurses in intensive care units. This time around, there has been no compromise agreement, and opponents of the nurse staffing proposal are campaigning fiercely to have the proposal defeated at the polls.

What Don't Opponents Like about the Patient Safety Act

Opponents to the nurse staffing proposal include the Massachusetts Health and Hospital Association, the Organization of Nurse Leaders (representing nurses now working in healthcare management), and ANA Massachusetts - the state chapter of the American Nurses Association. Under the banner of the Coalition to Protect Patient Safety, these organizations argue that the blanket proposal is too rigid and expensive, and could even force some smaller hospitals to close.

The coalition of opponents claim there is already a nursing shortage in Massachusetts and that the requirement to hire more nurses to cope with the new assignment limits will result in less experienced nurses caring for patients - which will make patients less safe. The coalition also claims the nurse staffing proposal will result in longer waiting times, and budget cuts in other areas of healthcare operations in order to comply with the Patient Safety Act.

To support its opposition to the nurse staffing proposal, the Massachusetts Health and Hospital Association commissioned a study which found that mandated patient assignment limits will cost the healthcare system $1.3 billion in the first year and $900 million each year after that. The Massachusetts Nursing Association disputes there is a nursing shortage in Massachusetts and argues that the cost to the healthcare system will decrease as the quality of care improves.

However, Nancy Gaden - the Chief Nursing Officer at Boston Medical Center - estimates that, if passed, the nurse staffing proposal will result in sixty-two bed closures, a decrease in capacity of the emergency department of more than one hundred patients, and eight hundred fewer childbirths at the medical center each year. She also claims the costs associated with complying with the Patient Safety Act would lead to major cuts in the medical center's community health program.

So, Who's Right and Who's Wrong?

There is no doubt there is a national shortage of nurses, and the US Bureau of Labor Statistics predicts 1.1 million additional nurses are needed by 2022 to avoid a further shortage due to retirements, burnout, and nurses leaving the profession because of the increasing rates of violence in the healthcare industry. However, those in favor of the nurse staffing proposal claim there is an oversupply of nurses in the Bay State due to Massachusetts' nursing schools graduating 3,500 nurses each year.

With regard to the cost of hiring additional nurses to comply with the patient assignment limits, an independent analysis was conducted by the Massachusetts Health Policy Commission (PDF). The Commission determined healthcare facilities would need to hire between 2,286 and 3,101 additional nurses to meet the ratio requirements at a cost of between $676 million and $949 million, and noted that Massachusetts already had a higher-than-national-average nurse-to-patient ratio.

The Commission also conducted a comparison between the proposed initiative and the situation in California - the only other jurisdiction to have state-mandated patient assignment limits. Although not an apples-for-apples comparison due to differences in the scope of Californian law and the proposed Patient Safety Act in Massachusetts, the Commission's four key takeaways from the comparison were:

1. There was a significant increase in nurse staffing in California hospitals post-implementation of ratios.
2. There was a moderate effect on Registered Nurses´ wages post-implementation of ratios.
3. There was no systematic improvement in patient outcomes post-implementation of ratios.
4. There has been no comprehensive, retrospective analysis of implementation costs.

The Good, the Bad, and the Solution

Regardless of who's right and who's wrong, the outcome of November's vote will have implications for both sides of the argument. If Massachusetts' citizens vote in favor of the nurse staffing proposal, nurses will be less likely to suffer from workplace burnout and violence, while the healthcare industry will have to find the funds to pay for increased staffing costs. If the vote goes against the initiative, the fact the proposal was brought to a vote will raise the profile of the problem, while failing to resolve it.

A potential solution to either outcome is a Geo-Poll tool for shift management. This tool has many valuable uses and, in the context of Massachusetts' nurse staffing proposal; it can be used to ensure safe nursing levels are maintained without healthcare facilities having to divert funds from other critical healthcare operations. The concept behind the Geo-Poll tool is simple, and it is easy for nursing administrators to use. Whenever a shift is understaffed - or forecast to be understaffed - nursing administrators send a single message simultaneously to all the nurses suitable for covering the shift. The message is in the form of a poll, asking a simple question with a choice of answers. An example would look like this:

Q. Looking to cover two early shifts in the Oncology Unit. Are you available?
A1. Yes
A2. No

Messages are delivered to nurses' mobile devices by email, SMS text, and voice broadcast. Emails contain a link the recipient clicks to answer the question, while responses to SMS texts and voice broadcasts are controlled by the keypad on the mobile device. The poll has an auto-close feature, so as soon as the nursing administrator has received (in this case) two positive responses, the poll closes - thus avoiding confusion and the scenario in which nurses re-arrange other commitments unnecessarily.

The Secondary Benefits of a Geo-Poll Tool

As we discovered in our recent survey of “Emergency Preparedness and Security Trends in Healthcare”, a communications gap in healthcare facilities exists that can result in emergency messages not getting through to the right people at the right time - potentially placing staff in danger. Our survey also found that perceived safety concerns in the healthcare industry do not necessarily reflect day-to-day reality, and consequently there is a lack of coordination when events occur that staff are ill-prepared for. Sign up for our webinar on October 25th to not only access the survey results, but also hear from healthcare industry experts discussing hot topics in emergency preparedness.

As well as being able to resolve understaffing issues quickly and inexpensively, a Geo-Poll tool is a go-to solution for other vital communications. The Geo-Poll tool can be used to notify staff of events affecting healthcare facility operations and provide information of ways to overcome these events. Although it is not necessary to send the messages in a Q&A format, by requesting a response, nursing administrators can ensure the messages are reaching their intended recipients.

This solution makes healthcare facilities safer and more secure, and can be managed from any Internet-connected device - meaning it is not necessary for a nursing administrator to be physically present at a hospital in order to resolve understaffing issues or ensure business continuity when an adverse event occurs. You can find out more about the nature of the adverse events we found by downloading our survey here.

A recent survey reveals that there might be a disconnect between how healthcare preparedness planning efforts are implemented and the reality of actual incidents occurred.

On Thursday, October 25th, a webinar called "Expert Panel: Triaging Healthcare Emergency Preparedness Today" revealed key findings from a recent survey, Emergency Preparedness and Security Trends in Healthcare. The survey polled over 300 healthcare professionals, mostly involved in security, preparedness and safety initiatives. One of the findings that will be covered during the webinar focuses on the biggest safety concerns respondents are dealing with.

"The number-one safety concern plaguing healthcare leaders is weather events." 

Weather events came out as the top safety concern for healthcare leaders, followed by active shooter incidents as a second-leading safety concern. Recent weather catastrophes such as Hurricane Harvey have brought to light the fragility of healthcare institutions, which for the most part, have to remain open and operational during these events. 2017 was particularly hard, with natural disasters estimating to cost the United States approximately $306 billion in damages. Hospitals hit by Hurricane Harvey estimated that natural disaster costs totaled up to $460 million.

Second-Leading Safety Concern: Active Shooters

What's interesting about active shooter incidents being a close second place safety concern is the rarity of these incidents. In fact, according to the latest FBI active shooter statistics, an active shooter is more likely to strike at an area of commerce than in a healthcare facility. 

Other pressing issues such as workplace violence are also covered in the Emergency Preparedness and Security Trends in Healthcare report and while the third leading cause of death for healthcare workers is due to workplace violence, interestingly, it was not considered a top safety concern by survey respondents. 

However, this shouldn't stop healthcare facilities to be prepared for all of these types of incidents. The focus should be on preparedness efforts for not only the seemingly more alarming incidents, but also for incidents that are more likely to occur such as weather events. 

Listen to Our Conversation About Healthcare Emergency Preparedness 

Hear what your colleagues think about the findings and how the healthcare industry can enhance their emergency preparedness initiatives. Our webinar held on October 25th featured emergency managers from Middlesex Hospital and Hartford HealthCare. Listen to the recording and download a copy to the survey report, Emergency Preparedness and Security Trends in Healthcare. 

Employees are busy. Every day, workers tackle projects, attend meetings, work with customers, problem solve, and, of course, receive, read, and send out e-mails. According to the Radicati Group, the average employee sends and receives over 200 e-mails a day. 

There are studies that show employees spend two to six hours a day sending and receiving e-mails each day. Given the influx of e-mails in employee inboxes, it’s not a surprise that employees might overlook important company updates sent by e-mail.

It’s easy for businesses to communicate company updates, weather alerts, building closings and local construction updates via e-mail. However, given the number of e-mails employees field on a daily basis, it’s possible that some may misplace, delete, or not see a message containing crucial company information. In the case of emergency information or important market related e-mails, missed messages can cause the spread of misinformation and rumors. Employees might not check their e-mail outside of work hours, or certain messages might not reach multiple departments. There’s also the matter of remote employees, who might be out of reach of the information. If all employees don’t receive necessary information, there can be major consequences for the business in question, from lost profits to disengaged workers.

In order to keep employees engaged, informed, and safe, businesses should invest in technology for communication. Employers need to consider employees whether they’re in the office, in the field, or traveling, and this means thinking outside the box of e-mail. Technology can help prevent these gaps in communication, especially when it comes to safety and wellness. By leveraging technology, businesses can keep employees informed when it matters most – during an emergency or impending event. Here are some of the ways that businesses can strengthen employee communication with technology.

1. A Clear Signal

Employers should first figure out what type of message they want to get out and how it will resonate with employees. If the message is an emergency update, such as a cyberattack or active assailant, it will require different procedure than a message about a staffing issue or power outage. This is where establishing a clear signal comes in.

A few companies are still relying on phone trees, intercom, or public address systems to contact employees, which are less reliable. Even worse, fewer employers are engaged with these networks. Instead, many are more likely to turn to email, instant messaging, or a social collaboration network to communicate. In general, mass notification systems, intercom or public address systems, company mobile apps and instant message, or social/collaboration apps had greater success at grabbing employee’s attention. However, mass notification systems and company mobile apps are most effective for contacting employees in a fast, reliable manner.

While e-mail can reach 95% of employees, it might only engage 66% of their attention. One example of an instant communication that will more effectively engage your business community is a push notification or alert. Sending out a high-value push notification is an effective way to get employees to engage with a message, but be aware of alert fatigue, which occurs when communication is too frequent.

Before sending out an alert, be sure to follow these guidelines. This will help prevent alert fatigue as well.

• Establish policies about how frequently they send out communications
• Make the language straightforward
• Include current information
• Make directions easy to follow and understand
• Figure out who will get the messages
• Have up-to-date employee contact information

 2. A Safe Workplace

This year, the #MeToo movement brought the issue of workplace violence and harassment to the forefront of the national conversation. The Equal Employment Opportunity Commission found that between 25-85% of women in the workforce will experience sexual harassment in the United States. These alarming stories and statistics demonstrate the need to revisit and bolster workplace safety efforts.

Promoting a safe work environment has many benefits for a business. In addition to the most important goal, promoting a healthy, productive workplace, these efforts will also benefit the company financially. Employers should also consider other forms of workplace violence - including verbal or written threats, physical or verbal harassment, physical assaults and even death. High-risk workers include delivery drivers, healthcare professionals, public service workers, customer service agents, law enforcement personnel and those who work alone or in small groups.

It’s possible that your workplace already has workplace safety procedures, but are these resources being communicated to employees? Half of all respondents in Rave’s Workplace Safety and Preparedness Survey weren’t aware of their company’s emergency plans for workplace violence and active shooter incidents. This is another scenario where communicating policy or resources via a mass notification system can prove valuable.

Technological advances can help businesses support their employees and encourage them to come forward about workplace violence, sexual harassment and other conflicts. Having an emergency call button on hand can improve emergency response in the workplace, giving workers the ability to reach security or law enforcement in case of a situation that may put their safety in danger.

Another valuable tool is anonymous two-way tip texting. Employees are more likely to report suspicious or dangerous behavior if there’s more privacy. Confidential tip texting allows employees to directly communicate with their employer’s security staff or relevant personnel. The two-way messaging feature helps them report any suspicious activity, along with text and images, discreetly through their smartphones. It gives employees an opportunity to report an incident without fear of retaliation and puts safety into their own hands.

3. Put Key Information in a Central Location

In the mobile phone age, employees likely expect information to be immediately and readily available. Businesses can help their employees stay organized and connected through a call directory, which would include important employer contact information. This directory would allow a business to include the phone numbers of human resources, travel, IT and facilities so their employees can reach out to these departments faster and report any issues and concerns. This can be especially valuable if employees are working remotely or are out of office. By putting all the information in an accessible location, it can speed up communication.

A content directory could feature company information in a central location. The directory could post company news, holiday schedules, travel agent contacts and human resources policies and procedures. This directory would also be compatible with a company app, putting all of the resources employees need in a convenient location. By offering the tools employees need in one place, they are more likely to check the app and communication will be improved overall.

To learn more about how technology is helping businesses strengthen their employee communication strategies, download the whitepaper.

It’s hard to believe Rave has been in business for 14 years. As I was reviewing some documents, I happened to notice that Rave’s birthday is quickly approaching. I figured this is a good time to look back at the past 14 years and how we’ve come to where we are.

A Look Back at Rave's History

2004 – Rave was founded. After founding and building a company that leveraged carrier-based location services to helping manage logistics and service companies, three founders see an opportunity in helping better connect Higher Education Institutes with their students. 

2005 – First clients brought on board. Montclair State University and the University of Southern Florida are still Rave Customers.

2006 – Montclair State is recognized by the Jeannie Clery Foundation for its use of Rave Guardian in helping improve student safety.

2007 – Virginia Tech Shooting. This tragic event was a seminal moment is Rave’s history as colleges and universities turn to proven vendors to help them further improve their ability to communicate during emergencies.

2009 – Rave launches Smart911. Within first year of launch 3 documented live saving incidents: heart attack victim, seizure, and allergic reaction. Rave surpasses 100 client mark.  

2010 – Rave is selected as winner of IDG’s 2010 21st Century Achievement Award. 

2011 – Winner IACP Excellence in Technology Award for work in Nashville TN with Smart911. Rave supports clients in all 50 states.

2012 – Rave Surpasses 500 client mark. Arkansas is first to deploy Smart911 statewide. Sandy Hook school shooting prompts Rave to begin working on enhancing communication between 9-1-1, first responders, and school personnel. Hurricane Sandy shows the need for emergency management agencies to better collect and manage information on vulnerable populations, and Rave enhances its Prepare product.

2014 – Rave launches Rave Panic Button after close collaboration with Snohomish County, WA Schools, Newtown, CT and others. Rave offers 9-1-1 centers and public safety agencies tools for better collecting and managing information about facilities in their jurisdictions.

2015 – Rave surpasses 1000 client mark. Rave is awarded is 14th patent.

2017 – Rave surpasses 2000 client mark, with many clients representing hundreds of agencies and/or schools. 20 million active users, and protecting a population of over 50 million. Rave sends 500 million emergency messages, processes approximately 18% of 9-1-1 calls in the country, and is involved in 5000 panic button activations. Rave begins selling products into the enterprise market and acquires two companies expanding its geographic footprint into Canada and also it’s breadth of services available.

2018 – Which brings us to 2018.

By any measure this has been a year of growth and transformation. This year will mark our 10th consecutive year of double digit growth, with the last 3 quarters being the largest in the company’s history. Through strong partnerships we are delivering improved location information on 9-1-1 calls from smart phones, greatly improving the ability of responders to locate and help callers.

Rave Panic Button is now protecting thousands of schools from Washington DC and Long Island NY, to counties in Florida and across the country. Smart911 just launched in the City of Chicago, further growing the list of major metropolitan areas supporting this life saving service. New apps were launched for both Smart911 and Rave Guardian that have been extremely well received and already have thousands of downloads. 

Our annual Rave Summit user group was the largest ever and attended by safety officials from 30 different states. The team is growing rapidly, hiring unbelievably talented folks in all departments.

Finally, most importantly, we continue to hear from our customers about how we are helping them help their constituents. We launched a series of regional events this year to be able to spend more time sitting down with our customers and hearing their use cases and how we can better serve them. It is incredibly motivating and an honor to be able to provide products to an amazing group to clients that are helping to improve safety and ultimately lives.

Although the majority of recent active shooter incidents have occurred in school environments, healthcare facilities also face the threat of an active shooter. Consequently five government agencies have collaborated to produce a guide to the five stages of preparedness for active shooter events in medical environments.

During an active shooter incident, the natural human reaction - even for those who are highly trained - is to be startled and feel fear and anxiety. Healthcare facilities have to be prepared for this natural reaction and incorporate it into their “all hazard” Emergency Operation Plans (EOP).

Due to the unique circumstances of an active shooter incident, the Departments of Health and Human Services, Justice, and Homeland Security - together with the FBI and FEMA - have produced a guide to the five stages of preparedness for active shooter events in medical environments.

The guide - “Incorporating Active Shooter Incident Planning into Healthcare Facility Emergency Operations Plans” (PDF) - is not intended to replace the six Joint Commission’s Emergency Management Standards, but rather to provide advice about how to better prepare for an active shooter incident.

The Five Stages of Preparedness

The five stages of preparedness listed in the guide consist of prevention, protection, mitigation, response, and recovery. Throughout the guide there are examples of how the stages can be built into an EOP - for example:

• Prevention - Regularly changing the codes on doors with keypad access and controlling who has access to the codes.
• Protection - Providing designated safe rooms where staff, patients, and visitors can retreat to when the threat of danger occurs.
• Mitigation - The implementation of an effective communication system to alert internal security and external law enforcement.
• Response - Conducting drills and exercises to best prepare staff for active shooter incidents - ideally with the involvement of law enforcement.
• Recovery - Train staff in psychological first aid in order to restore the treatment/therapeutic environment as soon as possible.

Although none of the five stages is given higher priority over another, the guide stresses that active shooter incidents are unpredictable and evolve quickly. Because of this, the best communication system to implement is one that alerts internal security and external law enforcement simultaneously.

It is also recommended in the guide that emergency responders have advance information on locations where they are likely to find staff, patients and visitors unable to evacuate, and the location of available public address systems, two-way communication systems, security cameras, and alarm controls.

The Importance of Communication in Emergency Preparedness

A recent survey on healthcare emergency preparedness found that 7% of healthcare facilities from across the United States had experienced an active shooter incident within the last two years. While these incidents are still considered rare and are far less in comparison to other industries such as commerce, having a solid communication plan in place that aligns with your EOP is key.

 Courtesy of FBI - Designated Active Shooter Incidents from 2000-2017

One way to ensure communication during an emergency is through an emergency notification system that streamlines and improves hospital or healthcare facility communications throughout your organization. A simple interface sends alerts to all modes — email, voice, PA system, text, social media, and others — from any internet-connected device. As an easy cloud-based service installation, it integrates with your existing systems and infrastructure. 

Some systems can also send out geo-targeted polls. This unique poll-based alerting feature allows you to solicit information and location data from a select group of recipients through SMS text, voice, and email. This might be useful after an active shooter event, to find out the status of employees by simply asking "Are you ok?". Employees can provide a simple “yes” or “no”. This tool helps to humanize business continuity and extends employers’ capabilities to keep their employees safe at all times.

Alert fatigue - desensitization to safety alerts due to their sheer number - is an acknowledged problem in the healthcare industry. It is claimed to be responsible for more than two hundred hospital deaths in five years, but there could be many more deaths if healthcare emergency notifications are unheeded. 

In 2011, the Boston Globe published an article claiming more than two hundred patients had died in the previous five years due to alert fatigue. The article pointed to the increased use of healthcare technology as being responsible for desensitization to safety alerts, and reported that a 15-bed hospital in Baltimore had recorded an average of 942 critical alarms per day - or one alarm every 90 seconds.

A later study conducted at the University of California San Francisco (UCSF) School of Medicine recorded more than two and a half million unique alarms over a 31-day period. Researchers suggested a solution to this problem was to tailor alarm settings to individual patients or specific scenarios; but, because of the many different types of technologies in use, this is impractical.

Why Are There so Many Alerts in Healthcare Environments?

The reason for there being so many alerts in healthcare environments is due to hospitals being incentivized to adopt electronic health records and technology to maintain them. It has been estimated that the number of Computerized Provider Order Entry Systems (CPOEs), smart intravenous infusion pumps, and cardiac monitoring devices in use has increased seven-fold over the past ten years.

Although the digitalization of healthcare has had a generally positive effect on patient safety, the unanticipated consequence of alert fatigue has emerged. This consequence is of particular concern in scenarios where healthcare professionals are struggling to cope with the increasing cognitive load of healthcare environments or when a stressful situation occurs.

What Problems Could Alert Fatigue Cause during an Emergency?

In an emergency, healthcare professionals are subjected to the maximum cognitive load in a stressful situation. They have to execute hospital preparedness plans while their lives - and the lives of their patients - are potentially at risk. Naturally, in this scenario, it would be understandable if an alert was overlooked or unheeded; but what if the emergency notification itself was overlooked or unheeded?

With healthcare professionals being subjected to so many alerts each day, missing or ignoring an emergency notification is not an unrealistic notion. In busy departments, it would be expected that colleagues would identify the notification as an emergency and start auctioning hospital preparedness plans; but in quieter environments the consequences could be devastating.

A Solution to the Missed Emergency Notification Issue

A solution to the missed emergency notification issue is not - as some healthcare organizations have done - to install more electronic alarms or overhead paging systems. Instead, healthcare organizations should be looking at solutions that - as the UCSF study suggested - have tailored alarm settings, and that are unique from any other type of alarm.

Emergency notification systems that use multi-modal communication channels are the obvious solution. These systems can communicate emergency notifications by voice broadcast, SMS text, email, and other media to ensure the broadest reach of any notification system. They also have the advantage of communicating the nature of the emergency and which hospital preparedness plan to action.

With regard to tailored alarm settings, healthcare professionals and other hospital employees should assign a unique ringtone to the emergency notification number - ideally a ringtone that means something to them. Then, whenever an emergency notification is received, the alert will not be overlooked or unheeded due to desensitization.

The Benefits of Rave Alert for Healthcare Organizations

Rave Alert is one of several emergency notification systems on the market that use multi-modal communication channels, but it has a couple of capabilities that make it the most appropriate solution for healthcare organizations. The first is that the system´s database can be segregated by location, role or other attribute. This capability has the benefit of minimizing disruption when an emergency notification is only relevant to employees in a certain area of a healthcare facility.

The second benefit is the geo-poll feature. This feature enables system administrators to send targeted follow-up alerts when necessary - or to inquire if employees are in need of assistance during or after the emergency incident. The feature works by sending a question followed by a choice of answers. For example:

Q: Do you need any assistance regarding the Hospital Preparedness Plan? 

A: No.

A: Yes, send more personnel.

A: Yes, we cannot evacuate.

As the geo-polls are answered, system administrators and incident managers can deploy resources as necessary. If the geo-polls are not answered, incident managers can identify where problems may exist and take further action to investigate and resolve the problems as necessary.

There are significant advantages of integrating an on-call staffing module into an emergency alert system with geo-polling capabilities - especially in the healthcare industry, where on-call medical staff may be required at short notice, and where many medical staff work alone in the community.

Since November 2017, healthcare entities in the Medicare and Medicaid programs have been required to comply with the CMS Emergency Preparedness Rule. The CMS Emergency Preparedness Rule was developed to address gaps identified in past responses to emergency events, establish a consistent framework for all healthcare entities, and encourage coordination among healthcare entities. It also was created to include healthcare system preparedness entities, public health preparedness officials, and emergency managers.

In addition to the Emergency Preparedness Rule, the U.S. Department for Health & Human Services (HSS) has run a Hospital Preparedness Program since 2003 with the objective of better preparing public health systems for “medical surge events” so they can respond more effectively. The HHS provides grants and funding for participating healthcare entities that participate in the program. In the financial year ended 2018, HHS paid more than $225 million to participating healthcare entities.

Core Elements of the Emergency Preparedness Rule

Risk Assessment and Planning

There are four core elements of the Emergency Preparedness Rule, the first of which is “Risk Assessment and Planning”. This element requires all healthcare entities to develop an emergency plan based on a risk assessment and using an “all hazards” approach. The emergency plan must focus on capacities and capabilities, and be updated annually.

Policies and Procedures

Based on the emergency plan, policies and procedures must be developed and implemented that - in Critical Access Hospitals and Long Term Care facilities - include the provision of subsistence needs for staff and patients whether they evacuate or shelter in place. The policies and procedures also need to be reviewed annually even if no changes are made to the emergency plan.

Communication Plan

A communication plan must be developed that specifically addresses communication and coordination with local, state, and federal officials, patients, and patients’ family. The healthcare emergency alert system implemented to execute the communications plan must be capable of alerting large numbers of people to an emergency in the shortest possible time, and communicating the nature of the emergency.

Training and Testing

Covered healthcare entities must also develop and maintain training and testing programs, including training in policies and procedures. Staff will have to demonstrate knowledge of emergency procedures and be provided with training at least annually. Facilities must conduct drills and exercises to test the emergency plan or participate in an actual incident that tests the plan.

Integrating a Communication Plan with a Hospital Preparedness Program

In terms of complying with the communications plan requirement of the Emergency Preparedness Rule, the healthcare emergency alert system implemented to execute the plan must be capable of facilitating two-way communications between key personnel over multiple channels of communication. There is a similar requirement in HHS´ Hospital Preparedness Program, in the context of providing situational awareness to incident managers in order to assist with decision making and resource allocation:

“The State and healthcare organizations, in coordination with Healthcare Coalitions, relevant response partners, and stakeholders, [must] have or have access to redundant, interoperable communications systems. These systems must be capable of communicating vertically with local, state, and Federal incident management and Emergency Support Function (ESF) #8, and horizontally with critical healthcare response partners in the community.”

In this respect, it makes sense to use the same solution to comply with the two sets of requirements. A multi-model healthcare emergency alert system that can communicate the risk of danger to staff and patients - and that can act as a command center during an emergency - saves time, save lives, and enhances coordination. Integrating an on-call staffing module into a healthcare emergency alert system with geo-polling capabilities can provide further benefits to healthcare entities, staff, and patients.

What is a Healthcare Emergency Alert System with Geo-Polling Capabilities?

A healthcare emergency alert system with geo-polling capabilities is a system that - as well as performing the functions mentioned above - enables administrators to send polls to groups of employees. The polls are typically simple questions followed by a small selection of answers. For example, if the system is being used as an on-call staffing module, the question could be “Are you available to work tonight?” The selection of answers would only have to be “Yes” or “No”.

In the event of an emergency, the poll would more likely read “Medical Surge Event. Please advise ETA” with a selection of times as the required answers. The responses would help with planning the response to a medical surge event, and could be sent to different groups of medical personnel in stages in order to better manage arrival times (i.e. ER personnel > surgical personnel > recovery personnel). This feature can be an important benefit when applying for accreditation with the Hospital Preparedness Program.

The “geo” element of the geo-polling feature is of benefit when an emergency has struck a medical center and administrators need to check on the wellbeing of their employees. A general poll can be sent to all employees asking “Are You Alright” with the selection of answers being “Yes”, “No - I need medical help” or “No - I need help escaping”. When responses to the poll are received, administrators also receive details of the employees´ locations so they can direct help where it is required.

Similarly, the geo-poll feature can be used to check on the wellbeing of medical personnel working alone in the community. The lack of a response would alert administrators to a potential problem and procedures could be initiated to locate the non-responsive member of staff - such as using the geo-poll feature to find out who is closest to the non-responsive member of the staff at their last known location.

In May of 2018, the Hospital Preparedness Program celebrated fifteen years of enhancing the ability of hospitals and healthcare systems to prepare for and respond to public health emergencies. We look at why the program was established, what its objectives are, and where it may be headed in the future.

Prior to the tragic events of 9/11, disaster preparedness rarely focused on healthcare issues. Due to an increase in international terrorism, the majority of efforts focused on repairing infrastructure and meeting the food, shelter and economic needs of displaced persons. Indeed, prior to 2001, the Emergency Preparedness Standards for Hospitals issued by the Joint Commission on Accreditation of Healthcare Organizations primarily concerned bomb threats, floods, and loss of utilities.

The attacks on the World Trade Center and Pentagon highlighted how unprepared the healthcare system was for mass casualty terrorism. When hospitals in New York City and Washington D.C. initiated their disaster response plans, they found they were not adequately prepared for the magnitude of the events. Both hospitals experienced problems with communication, patient tracking, data management, staff support, personnel identification, and overcrowding.

A further terrorist event in 2011 - the mailing of envelopes filled with Bacillus anthracis (the bacterium that causes Anthrax) to media offices and U.S. Senate offices - revealed a different level of fragility in hospital preparedness. Emergency response personnel were asked to investigate countless incidents of “suspicious powder”, but, at the time, few healthcare professionals were familiar with identifying symptoms of the bacterial disease, treating it, or preventing it from spreading.

Federal Response to Shortfalls to Healthcare Preparedness

The lack of fully effective responses to 9/11 and the Anthrax attack prompted the federal government to pass the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. This Act built upon existing programs to establish a National Bioterrorism Hospital Preparedness Program. The initial objectives of the program were for the better preparation of healthcare systems to respond to bioterror attacks and other public health emergencies such as flu pandemics and natural disasters.

In order to help meet the objectives, in 2003 the Health Resources and Services Administration (HRSA) made $498 million available in funding for the development and implementation of cooperative agreements which would improve collaboration between healthcare systems. In order to be eligible for a Hospital Preparedness Program grant, healthcare entities would have to use the funds to complement their existing preparedness programs in the areas of:

• Improving bed and personnel surge capacity.
• Increasing decontamination and isolation capabilities.
• Strengthening interoperable communication systems.
• Bed tracking and personnel management.
• Hospital evacuation planning.
• Fatality management planning.
• Emergency training, education, drills and exercises.

However, in the aftermath of Hurricane Katrina in 2005, it became evident grants had been used to fund individual hospital preparedness programs, rather than develop regional cooperative agreements. Congress responded by transferring responsibility for the Hospital Preparedness Program to the Office of the Assistant Secretary for Preparedness and Response (ASPR) - tasking the department with developing Healthcare Coalitions for better information sharing and response coordination.

How the Program has Developed Since 2005

Since 2005, Healthcare Coalitions have developed from being relatively small cooperative agreements to multi-agency organizations that not only count healthcare facilities among its members but also local, state and federal jurisdictional authorities. There are now 470 Healthcare Coalitions around the country comprised of over 31,000 members. During the past fifteen years, the Hospital Preparedness Program has overseen an investment of nearly $6 billion in the nation's healthcare system.

The investment has been effective in changing the way healthcare is delivered during public health emergencies. Whereas prior to 2005, competing hospitals were reluctant to share information, issues existed about liability exposure, and few healthcare entities collaborated with emergency management or public health, there are now many examples of how Healthcare Coalitions have mitigated the impact of public health emergencies to ensure the best possible outcome for the greatest number of patients.

The 2009 H1N1 “Swine Flu” Pandemic

Although the 2009 H1N1 “Swine Flu” pandemic claimed more than ten thousand lives, the outcome could have been much worse had it not been for collaboration between multiple agencies to rapidly distribute anti-virus vaccines, and to test, diagnose, and treat an estimated 57 million Americans who contracted the disease.

Hurricane Sandy in 2012

Hurricane Sandy in 2012 proved to be the first major test of public-private coordination since Hurricane Katrina. Under the Hospital Preparedness Program, patients from twelve evacuated hospitals and other healthcare facilities in New York State were successfully relocated, and more than two thousand healthcare professionals were brought in from other jurisdictions.

The 2013 Boston Marathon Bombing

Within minutes of two explosive devices being detonated near the finish line of the 2013 Boston marathon, the city's hospitals went into emergency response mode. It has been calculated that - due to the Hospital Preparedness Program, training, drills, and coordination between healthcare facilities - more than 140 lives were saved.

The U.S. Ebola Outbreak that Never Happened

It is not known how many lives were claimed worldwide by the Ebola outbreak of 2013-2016 due to massive underreporting. However, in the United States, thanks to a coordinated effort to test, isolate, and treat hundreds of people potentially at risk from the highly-contagious and life-threatening virus, there was only one fatality.

Ongoing Issues and Where the Program May Be Headed

Current ASPR guidance requires hospitals in the Hospital Preparedness Program to have redundant and reliable emergency communication systems. Most healthcare facilities have improved their communication capabilities, but issues exist with the modes of communication used and how they might be impacted by a natural disaster or infrastructure damage.

Furthermore, whereas some states and municipalities have developed healthcare-specific emergency operations centers (HEOCs), there are issues about how these EOCs communicate with each other. Without compatible systems being deployed, the risk exists command and control functions will become isolated and dysfunctional during an emergency event that is rapidly expanding in scale and impact.

These issues need to be resolved before plans to create a coordinated national disaster health response system can be realized. The coordinated national system would not only be used in times of emergencies, but also to resolve the current healthcare crisis which sees 50 percent of emergency departments operating at over capacity, and 500,000 ambulances diverted each year from the nearest hospital due to emergency department overcrowding.

What has been achieved in the fifteen years of the Hospital Preparedness Program is certainly worth celebrating, but there is still a long way to go.

Determining when a panic button is required depends on two different factors. A panic button might be required by law or it might be provided for ethical reasons even when it is not mandated by legislature.

There has been a lot of media attention given to panic buttons recently; the tragic school shooting in Parkland, Florida, in February raised the issue of school safety, but the topic has also come up in reference to workers in the hotel industry campaigning for greater protection against sexual harassment. However, campaigns in favor of panic button legislation have been ongoing for many years - some successfully, others not so successfully. Of course, a community does not need a legal mandate to consider leveraging this technology for safety purposes. There are several ways this tool can be implemented, and both prove it's necessity. 

The taxi industry is a prime example of the law requiring the use of a panic button. In New York City, legislation was passed in 1994 requiring leased yellow cabs to be fitted with “trouble lights” following a spate of murders and assaults on taxi drivers. Campaigns to install panic buttons in the rear of taxis to protect passengers from assault by taxi drivers were not as successful in New York City; but, in Washington DC, a similar campaign found success in 2012, and panic buttons for both drivers and passengers are now a licensing requirement.

In other areas of the transportation industry, panic buttons have been a regular feature on buses and school buses since the Department of Transportation found GPS-enabled panic buttons improved emergency response times by 18 minutes and off-route detection by more than 3 hours. There is no mandate for state and local governments or school districts to install GPS-enabled panic buttons on their buses. Many choose to do so to enhance the safety of bus drivers and their passengers. There's also the question of ride-share technology - Uber recently installed a panic button feature in the app, responding to assault reports by drivers. 

Little Done to Support Healthcare Workers

The discussion about panic buttons in the transportation industry is of particular relevant to lone workers, but these legal conversations fail to address the dangerous situations workers face on a daily basis in the healthcare industry. Despite healthcare and social assistance employees making up only 12.2 percent of the working population, nearly 75 percent of workplace assaults occur in the healthcare sector. A study in 2017 found the majority of physical attacks are instigated by patients (64 percent), followed by families (30 percent).

However, little has been done to provide healthcare workers with access to panic alarms either in brick-and-mortar medical environments or in the community. This may have to do with certain solutions that have been suggested in law are impractical (fixed panic buttons at nursing stations) or because they too complicated - for example a “Code Blue” paging system that has a different code for every type of emergency and every location. It's too difficult to remember the right code to use in a stressful situation, especially when the hospital and healthcare facility already operates on a safety system that differs from other public and private locations. 

Panic alarm pendants have also been suggested as a solution, but these have their limitations. Pendants only work within range of a base console and so are impractical for medical professionals moving between departments and community nurses working in the field. Furthermore, should an incident occur in which a medical professional requires urgent assistance, the location communicated to security personnel will be that of the base console. The incident could be taking place up to 200 yards away. This also fails to address the fact that many physical panic buttons contact an alarm company first and foremost, which does little to help a healthcare employee working in a high-stress environment. A medical emergency can turn in seconds, and the time to reroute the lack means these panic buttons are impractical for this environment. 

Schools and Hotels Determine Need On A Case by Case Basis

With regards to panic buttons for schools, legislation at state and local level is at various stages of consideration. Only the state of Arkansas has passed legislation mandating panic buttons in schools, while the states of New York and New Jersey are relying on the passage of ballot measures in this year´s elections to provide the finance for statewide panic buttons. At the local level, several school districts have themselves funded panic buttons, rather than wait for state and local governments to provide funding. Hopefully, grants for this technology will help local communities implement a panic button in schools, libraries, and other public spaces. 

Panic buttons for certain hotel workers is also in the consideration phase. Since 2012, workers belonging to the New York Hotel Trades Council union have been provided with panic buttons when they have to work alone in guest rooms. The states of Washington DC and Seattle followed suit in 2016; and this year Chicago passed an ordinance requiring a panic button system was implemented in all the city's hotels for lone workers.

Union discussions are underway with hotels in Las Vegas - where the Marriot and Hyatt hotel chains provide their staff with personal distress alarms voluntarily - and also in resorts situated in Miami Beach Florida and Long Beach California. Union groups hope to get support for panic button ordinances this year, although it is not yet known whether the ordinances will protect all employees or just unionized employees who work alone as in New York.

Where the Discussion on Panic Buttons is Headed

Regardless of whether legislation is passed or not, the discussion on panic buttons seems to be focusing not so much on whether panic button systems should be installed (most parties believe they are a good idea in emergency scenarios), but what type of panic button systems should be installed. Fixed panic buttons systems are impractical in many emergency scenarios, as are wearable panic button systems for the reasons given above. The discussion is headed towards panic button apps, which offer a modern alternative. 

GPS-enabled panic button apps are simple to download and operate, and inform emergency services or security personnel about the nature of the emergency and the location of the emergency with a tap of a smartphone screen. The apps were chosen by the state of Arkansas to protect all K-12 students in the state, and may soon be seen throughout New York's schools after the state's Education Task Force recommended against fixed panic button systems.

GPS-enabled personal safety app systems would also be idea for lone workers - especially medical professionals working in the community - as they would help any employee facing dangerous situations on a daily basis in the industry. Furthermore, GPS-enabled panic button app systems prove to be effective in emergency scenarios, they do not have the hardware costs associated with fixed and wearable panic buttons systems and save time by connecting directly with local first responders instead of routing the call through an alarm company.

A recent focus has been put on how immigration raids impact workplace safety. While not new, the issue was thrusted into the spotlight after an incident in March of 2018 when federal immigration agents surrounded a meatpacking facility in East Tennessee. The confrontation would be the largest single workplace raid in over a decade with over 97 undocumented workers arrested and taken into custody, removing many from their families. 

The incident is just one in a growing number of ICE raids in workplace settings, and these incidents have consequences for employers managing workplace safety. The fear of deportation discourages employees from reporting important information while on the job, and potentially jeopardizes workplace safety.

The Trump Administration has a "zero-tolerance" policy on immigration and kept a campaign promise to ramp up workplace raids. According to the Washington Post, acting ICE director Tom Homan ordered the number of work-site inspections and operation disruptions to increase by four or five times in 2018. The administration intends to target industries that draw people who are in the country without documentation, and to punish the employers who hire these people. The number of immigration-related arrests have increased overall, and is up over 40% since Donald Trump took office. In January, ICE officials targeted 7/11 stores across the United States as well, with agents showing up at over 98 locations and making 21 arrests.

Immigration raids have the potential to create an adverse effect on workplace safety. These targeted investigations, which were more common during the George W. Bush administration, can instill fear in a workplace, but also throughout the entire community. In Tennessee, the raid on the meat processing plant sent waves through the small town. “People are panicked,” Stephanie Teatro, a co-executive for a local Immigration Rights Organization, told the Washington Post. “People are terrified to drive. People are terrified to leave their homes.” In these situations, many immigrants, even if they have citizenship, will want to keep a low profile while at work. 

Fear can stop employees from reporting dangerous events in the workplace, whether it is dysfunctional machinery or harassment from a coworker.  Even if the company, factory, or other workplace doesn’t employ workers with undocumented status, this fear can still have an impact on the workplace. Many new employees are hesitant to report suspicious activity, should it draw attention to themselves. Even people with citizenship status don’t want to put their family members in a compromising position. In Tennessee, only 21 people taken from work at the meat-packing plant were taken to trial and deported, meaning most of the workers were arrested without cause. Nobody wants their family to experience a parent or spouse being incarcerated in a detention center, and these arrests can be traumatic for individual workers. 

It’s well known that the restaurant, farming, and food processing industries depend on immigrant workers. The reality in these industries is that many of these roles are difficult work and if employers are unable to fill positions with American citizens, they will turn to undocumented workers. This poses a unique challenge for safety, as these are also all fields with high rates of workplace injury and other safety challenges. According to the Population Reference Bureau, foreign workers, including individuals who are documented, make up 15% of the job market in the United States, but account for 18% of all job fatalities. 

The food processing complex poses the biggest physical risks, but immigration fears pose obstacles in other industries as well. The restaurant world in particular has a high rate of workplace violence, with women especially vulnerable to verbal or physical assault while at work. For this reason, employers and business owners should be aware of how ICE raids impact workplace safety and prepare accordingly. There are several ways to improve safety practices amidst the current climate, and by improving communication and leveraging technology every workplace can be kept safe.

How to Encourage Workplace Safety During the ICE-Raid Era

ICE raids can often instill chaos and panic, and the more information employees are given, the less likely these incidents are to negatively impact the workplace culture in the short and long term. Communicate to employees that every worker, even if they are undocumented, has rights in the case of a raid. Many times, ICE officials will use warrants signed internally, to circumvent a court-ordered warrant. If possible, be sure to read the paperwork in its entirety, as ICE needs permission to enter a private property. It’s not a bad idea for employers to read and question a warrant – even if the facility doesn’t have undocumented people working inside, a raid can cause disruptions and instill fear in the community in the long term. Employees should understand that under constitutional law they have the right to remain silent, no matter what their immigrant status. ICE often relies on “informed consent” to arrest workers, and it’s not necessary to give verbal permission.

These practices are all legal and communicating employee rights can help dispel some of the tension and fear around ICE raids. A mass notification system can help a company or institution contact all employees in a timely manner, and workers can even opt to receive information in their language of choice. If employers communicate how a potential ICE raid might impact the workplace, they should be able to address and manage fear. Make sure that employees feel comfortable reporting issues in the workplace, and that it won’t jeopardize their position or the safety of other workers.

Leveraging Technology To Improve Workplace Safety

In many instances, the threat of ICE coming into the workplace can prevent workers from telling higher-up people about technical or interpersonal issues on site. An anonymous two-way tip texting system can help with self-reporting, as workers are able to communicate with managers at the company should an issue arise without worrying for the safety of their family. Many of the employees from immigrant backgrounds had lived in the United States for over a decade, but still faced detainment. Given the size and scope of these interventions, even longtime citizens fear these searches. 

In June, ICE carried out a raid on Fresh Mark, a meatpacking plant in Ohio. The raid was the largest in United States history, with over 100 federal agents surrounding the facility and arresting over 146 employees. According to Bloomberg, the facility was issued 13 citations and a $211,194 fine after an employee was killed by a meat-skinning machine in December. OSHA inspections revealed that the employee got his leg caught in a operating auger at the Canton plant, amputating his leg and killing him. The fine was for Fresh Mark's failure to put the proper guards for the auger, which could have prevented the accident.

Bruce Goldstein, president of the advocacy group Farmworker Justice in Washington, told the publication that there is a direct correlation between and unreported safety hazards. "Many of those workers are too afraid of retaliation to challenge unfair or dangerous illegal conduct," he said. "They’re generally too afraid to go to a government agency to report illegal or dangerous practices by their employers. They’re usually to afraid to even go to a lawyer to help them." So, taking the potential risks that immigration raids pose, it's important to find ways to keep communication between facility managers and employees open. 

"Many workers...are too afraid of retaliation to challenge unfair or dangerous illegal conduct. They’re generally too afraid to go to a government agency to report illegal or dangerous practices by their employers."

For workers, there’s also the issue of wage or hour violations and verbal or physical violence in the workplace. Many people avoid coming forward when these events occur, even before the escalation in immigration enforcement over the past couple years. An anonymous tip-texting system can help manage appropriate workplace practices, across ranks in the company. It can also help address issues of harassment or other inappropriate workplace behavior, since statistics demonstrate that women are afraid to report these behaviors, even in work environments where the looming threat of immigration agents are not a consideration. These raids leave low-wage workers who are women especially vulnerable, and employers must consider ways to this demographic of worker safe, as they are unlikely to report abuse on site unless there is a private medium of communication. 

In recent years, a number of hotels have started issuing wearable panic buttons to employees whose job involves entering a guest room or bathroom alone. However, considering the delays in responding to the Mandalay Bay hotel shooting last fall, should hotels be offering panic buttons to all staff?

In Seattle and Chicago, hotels are required by law to provide panic buttons to employees who work alone. Panic buttons must also be distributed to lone employees in unionized hotels in New York and Las Vegas, and the Marriot Hotel chain is voluntarily working on a pilot project to equip employees who work alone with “personal distress alarms”. Employees of the Hyatt Hotel chain already have them.

The purpose of equipping housekeepers, engineers and room service staff with panic buttons is to allow them to instantly summon help if they are sexually assaulted or harassed by a guest – a job hazard worker advocates say is more common than most people realize. They can also be used to alert hotel security to a fire or to request medical assistance if an unresponsive hotel guest is discovered in a room.

In Seattle, the first city to pass a hotel panic button law on 2016, housekeepers are reporting they feel safer according to union organizer Abby Lawlor. Lawlor says she is unaware of specific circumstances in which the panic buttons has been used to prevent a sexual assault, although they did prove useful when a group of housekeepers got trapped in an elevator at one Seattle hotel.

The Mandalay Bay Hotel Shooting in October 2017

On October 1st, 2017, gunman Stephen Paddock fired more than a thousand rounds of ammunition from his 32nd floor room in the Mandalay Bay hotel at concertgoers attending the Route 91 Harvest music festival on the Las Vegas Strip. Paddock killed 58 people and injured a further 851 concertgoers during a ten-minute shooting spree, at the end of which he shot and killed himself.

Shortly before the shooting started, a hotel security guard had been sent to the 32nd floor to investigate an open door alert. On hearing the shooting, the security guard went to investigate and was shot in the leg. Both he and a nearby maintenance worker reported the shooting to their superiors and told them to call the police.

It took police officers already at the Mandalay Bay hotel (investigating an unrelated incident) approximately fifteen minutes to respond, and a further fifteen minutes for more officers to arrive at the scene - the delays being attributed to confusion over whether the shots had been fired from the Mandalay Bay hotel, the nearby Luxor hotel, or within the venue where the festival was being held.

Are Panic Buttons for Hotel Staff Enough?

Panic buttons have now been issued to employees at the Mandalay Bay hotel - but these only connect staff to managers in order to notify acts of abuse, assault or harassment. In an emergency, employees would be unable to communicate the nature of the emergency or connect directly with 9-1-1. Effectively, the Mandalay Bay hotel shooting could take place again with the exact same consequences.

A far more appropriate solution would be a mobile panic button app that connects directly to 9-1-1. With two taps of a screen, app users can notify 9-1-1 of an emergency, the nature of the emergency and its location. 9-1-1 dispatchers get details of the individual who has initiated the emergency call, and details of the environment in which the emergency is occurring - such as floor plans, access points and utility shutoffs.

An after-action report was released yesterday on August 27th, 2018 by FEMA, the Clark County Fire Department and Las Vegas Metropolitan Police Department detailing the entire emergency response at the Mandalay Bay hotel. What's made clear is that critical emergency response personnel were not on the same page as the incident unfolded. However, perhaps had the nature of the incident and its location had been immediately relayed to 9-1-1 dispatchers, coordination with other parties onsite and those responding to the incident could have been better orchestrated and the confusion that led to the delayed response could have been averted. 

While the incident that occurred at the Mandalay Bay Route 91 harvest music festival is at a larger scale, it showcases the need for better communication between hotel staff and security to enhance emergency preparedness.